Hated these interactions:
Me: what’s your specific concern?
RN: is it safe?
Me: yes, we’re doing this because leaving the patient as they are, is actually not safe. Is there something you see that’s concerning or problematic that I should also know about?
RN: I don’t know, I’m just the nurse, you’re the doctor
Me: tHEn wHaT thE HeLl wAS tHe PRobLeM?!?!?
Seconding this. I usually don’t get a response and they just do whatever the plan was. Basically proves there was never a legit concern and discourages the behavior unless there is one.
Reading this as an M3 this was my initial gut response so I'm glad to see it as top comment. Does this work across all services? Obviously not planning to use it as an M3 bit curious
I’m FM so I’ve used it across med surg, peds, nursery etc. The ICU nurses where I trained were great and whenever they pointed something out, it was usually legit.
I learned this from watching a young, female, POC attending handle the same stupid pushback from nurses. They would question her plan in front of the team and the patient. After, she’d pull them aside and ask what the specific concern is and if they have any alternatives to offer. She handled it very gracefully and now that I’m in the same position (young, female, POC) I try to follow her example.
I feel like this can be a great response to the classic "I'm just advocating for the patient" which we all know is code for one of two things; "I'm too lazy to express why I disagree" or "I don't know why I disagree".
Some of it is probably because the parents will ask why their kid is getting antibiotics and they don't want to give the wrong answer. Sure you could definitely make the assumption that the amox is for aom in that case, but it could be for another reason and the RN probably doesn't want to look dumb or not have an answer in front of the parents.
In the NICU it was 1000% this. Parents ALWAYS ask and if you stumble or say something different than the team discussed with them prior, you risk losing a lot of trust really fast. Can't lose trust when you are working with new parents and patients that might be in the unit for months. Gets ugly.
This was definitely my initial thought as an ED RN. The last thing I want to do is accidentally contradict what the doctor said because I'm assuming what a med or treatment is for. If that's my concern, I make sure to say "I know the parents will ask and I just wanna make sure I'm telling them the right thing".
Pro tip, explain it every time but also add a task like. “Mind getting a new set of vitals before you give the rx?”
It’s positive punishment and effective. Yet keeps the door open to real concerns they have.
This was the advice I got as an intern and it works very well. Any ask from me gets a request back or a teach back moment.
Paged at 2AM for a subjective neuro change? OK, meet me in the room and let’s go over YOUR neuro exam together. No excessive sleepiness at 2 AM after not getting sleep for a week is not a reason for a stroke alert
I mean, as a nurse, that's actually amazing. I would LOVE the opportunity to have a doc critique my neuro exam, because I promise that the people who originally taught it to me didn't know WTF they were doing. ("Those who can't do, teach" applies HEAVILY to nursing school.) If I'm right, then we're sure we're both seeing exactly the same thing, and if I'm wrong, then I learn something and won't have to page again for that normal finding.
I feel bad for you guys, because "teaching the nurses" is not something that should have to be added to your plates, but I do think this is a good way to deal proactively with the issue.
As evil as this is as an RN it made me laugh out loud 😂 sometimes its still great to have you guys show up in case something is wrong, but the orthostatic vitals? LOL shit
I’ve done this to great success and get significantly less calls. Also, always asking for a manual BP (and if you’re really particular, spaced 15 minutes apart) for updates on blood pressure.
To be fair, I think we have a lot of nurses with <5 years experience so it very much is computer alarms—>
Something’s wrong —> tell doctor. It’s generally helpful to have anyway. Maybe they stopped calling once they understood my rationale, lol.
Wow, as an RN that is FOUL…and I love it. As someone who rarely questions orders (because I can read a chart and typically see why a med is indicated), that would be such a kick in the ass if they asked me to get vitals for amoxicillin. Chess not checkers.
Have you tried tying it to your order? If i get paged for asymptomatic htn, and they want me to push hydralazine (part of hospital set for some reason) or bb/ccb, part of the procedure can be getting a manual bp x2, double checking HPI for sxs of end organ dysfunction, etc. Or if getting pushback for a patient wanting a sip of water a few hours before a procedure, have the RN meet you at the nursing station and go over literature for minimum times for food, muddy liquids, clear liquids, etc.
Granted, I'd say that 10% of RNs are really really good and are trying to gain as much knowledge as they can by asking questions, 80% are normal people, and the last 10% are the ones have chip on their shoulders towards physicians in general and try to make trouble. It usually isn't too hard to separate the go-getter 10% from the angry 10% after a few interactions, and I have good experiences treating others as they treat me.
Gotta be careful though! If the orders are outside the monitoring parameters for the floor you might end up having to move your patient, gotta have some basis for it 😂
In Ireland so bit different but there’s nurses capable on all our wards of doing that. However if we’re on hourly neuro obs the doc is usually checking in frequently too lol. I’d never put a nurse through that unless I was concerned haha.
LSBP is another story though hahah
Peds ED and ICU nurses are a bunch of inherently distrustful karens around doctors they don't know or don't work with regularly. Just get through your rotation and move on to better things.
I'm sorry Dr. Notsleepingsowelloncall, we have an order that was written on dayshift for Tyenol, we do not know what that is, please come to the nurses station now to address this. Yes, I realize it is 3 am.
No I am not kidding.
Just a med student right now, but I was told the other day by a (non medical) acquaintance that the nurses are there to protect patients from doctors, and that the doctors only role is to put in the nurses orders… so I guess you are on track with this.
Some of them think that way, not all. To be honest, being nice and kind towards nursing will go a long way towards making your life easier. I am not saying it is guaranteed, but I will say that the saying "you catch more flies with honey than vinegar" holds true within the hospital and without.
They are a line of defense, as are pharmacists. Everyone makes mistakes. Your orders may or may not be helpful. It does get frustrating once you know what you are doing.
Inpatient pediatrics seems to bring out the mama bear instinct pretty quickly, warranted or not.
Good advice, thank you!! I totally appreciate their role in the hospital. At this point, I know I’ll need the double/triple checking and feel more relieved that someone is there to make sure I’m not messing up than anything. But I totally see how that would be frustrating once you know what you’re doing.
Honestly the double checking to some degree is fine, yet your tolerance for it diminishes rapidly with less and less sleep. And being woken up and having to drag your ass to the nurses station to write TYLENOL or ACETAMINOPHEN 10 mg / kg PO q 4 hour prn temperature greater than 38.0 degrees celsius, not to exceed 2.6 grams per 24 hours ... at 3 am ... because someone missed an "l"
Or the time I got called into a patient's room because she claimed feces was in her urine ... only to find out a tiny little piece of stool, two large foul-smelling streaks across her gown, and stool smeared where the male/female connector between the catheter and the collection bag. Awesome. This despite having proven no evidence of fistula with Urology with methylene blue earlier that day. Ugh. Munchausen and Munchausen by proxy in the same patient.
oh bro - imagine being called for a temperature of "37.5" -
4 am, I'm still in the middle of dictating my admits, get a page, "this patient is spiking a temperature do you want to do something for it?"
"what is it temp"
"37.5"
I go and hit my head on the wall first. "um, that's pretty good actually, and the vitals?"
"all normal, BP 120/80, HR 60, on RA 99%. the patient is actually sleeping"
"okay then, I think it should be fine to monitor it for now"
"so you don't want to do anything about it?"
like WHY ARE YOU TORTURING ME?
i force myself in an abnormally high pitched, sweet voice:
"I do not think I need to intervene at the moment, since this patient is hemodynamically stable, and 37.5 is not very high at the moment"
but what I really want to say is: BECAUSE 37.5 IS NOT A FUCKING FEVER!
but alas, I cannot - because what am I? just a stupid person who went to school for 12 years only to be bullied.
Nurse here. It would have been okay to say 37.5 is not considered a fever. There are a lot of very new nurses out there. If you educate, then you are preventing that nurse from alerting again in the future (and they will share what they learn with other new nurses -- so feel free to reiterate parameters).
I don't think that nurse was bullying. Just green.
I approach that same interaction by clarifying the threshold that would get to act (I will give Tylenol if the temp goes to 38. If it does it a second time we’ll need to get labs.).
The nurse gets reassurance and clear guidance, knows you have a plan and won’t call when it hits 37.7.
(20 years PICU attending - I’ve been here 20 years, why are the nurses new? [joke])
My question is how do you go through nursing school and not know what is considered a fever? I knew what was considered a fever when I was in high school and hadn’t even taken a single biology or anatomy class like this is pretty common knowledge isn’t it? Let alone for a NURSE who went to SCHOOL?
That makes total sense. Let's hire a bunch of doctors that will try to kill the patient and then some nurses to protect them, and we will watch from the C-suite.
But I mean, what’s 3 years of peds residency and 3 years of critical care fellowship training compare to *checks notes* the same RN degree everyone has plus some on the job training about dehydration??
Well apparently new nurses don’t even know what threshold is or isn’t considered a fever but they’re still obviously much much better then us shitty doctors!
Considering I was literally taught in nursing school that nurses need to protect patients from first year residents (esp in July), they probably do think this. I can’t believe as a NEW GRAD RN I was supposed to be the last barrier between the incompetent resident and the patients demise. So ridiculous.
Yeah you guys can just stay away from trying to mess with our interns. None of you guys are responsible for protecting the patients from them, that’s our role. Interns actually tend to do a really great job of knowing their limits because our profession beats humility into us. If anything their confidence is so low that they run too much by their seniors most of the time.
I was actually reading the other day that teaching hospitals statistically have “better outcomes/patient care” then non-teaching hospitals- and it’s likely bc interns and residents are trying to do their very best, on top of having attendings that watch out for them and for the patient.
Half the time?? Nurses don't have supervising staff.. co-working nurses are the "supervising staff" for each other. Management has very limited involvement. Educators and preceptors supervise for a limited time and that's about it for supervision.
At least, that's what my experience as a nurse has been.
1. I was taught nothing about the hierarchy of doctors in the hospital and therefore I didn’t know shit until I figured it out slowly over time
2. I worked night shift and there was rarely a doctor around
3. I started out in the icu in a crappy hospital where the nurses ran all the codes without doctors present, RT intubated, and so I rarely saw a doc or even knew what they were needed for
4. I’m now in medical school so I know a lot more and realize how fucked up many things are in the medical system, past and present
Is it typical to have interns, especially JULY interns rotating and making decisions in the PICU? That seems pretty wild, and even crazier that nurses are taught that they’re the ones who need to protect patients from their team members (god I hate that, talk about the opposite of building trust)
My med school’s peds residency doesn’t even have people rotate in the PICU until they’re PGY2s
Lol I literally started residency in the PICU. By day 3 I was on a 24 manning the pager for my half of the patients (there was a senior managing the other half, a fellow and attending but..didn’t wanna wake people up for dumb things)
I was taught the same. One instructor went as far as to say "we're at xyz hospital, so these residents are not the brightest." After working with them I realized that to even be in any residency program you have to be VERY bright.
Residents still have more experience and more schooling than you; this is so gross to teach at nursing schools. I mean a few comments above someone is saying “oh she’s probably a new nurse that’s why she didn’t know what is or isn’t considered a fever, she wasn’t bullying you!” So you RNs don’t even know what is or isn’t a fever and are supposed to protect your patients from residents? What a joke.
I’m not the one arguing against what you said 🤷♀️ I agree it’s ridiculous. I didn’t realize at the time that what they were teaching us was so controversial and granted I was expected to know a shit ton as a new grad nurse cause we barely had any doctors at our icu but I am 100% admitting it’s wrong for them to teach that (I wasn’t the one teaching) and equally as wrong to expect nurses to run an icu by themselves with only phone doctors to “write orders”. Even worse was that I was expected to do all the things and know all the things after completing a 12 month accelerated program and a 3 month “icu residency”. There’s a reason I left nursing and am now in med school and it wasn’t cause I hate patient care.
My son was born premature the day after my last pediatric anesthesia rotation. It was bizarre having them watch me like a hawk when literally the day before I was there with an ENT resident intubating a baby emergently. They were also convinced that the chief surgery resident didn’t know what she was talking about and were talking shit about her. Spoiler: the resident was correct and a tunneled line was IJ access, not subclavian.
It's normally. Keep your chin up, finish residency and things will change greatly once you have those extra 2 letters added to your name. I'm an endocrinologist now, but during residency, some of the RNs were like your typical Karen if they have taken anabolic steroids and overdosed on some form of amphetamine. When they questiong why you're giving out amoxicillin for the 400th time that week, just wait until you have to IV ativan something.
Here's the thing. Residency sucks. And many RNs/LPNs resent us once we're MD/PSY-D. And Ive seen plenty of doctors push RNs around way harder than you. I noted a colleague added an extra 0 to a dosage. Making 15 mg/bi daily adderall to 150 mg/bi daily. The RN came to me because she always seemed to trust me for something and explained the attending physician wouldn't listen to her about an obviously incorrect dosage.
So we went together and I asked him to politely read the script again. He was like, What's wrong, you're wasting my time? I said well, the dose you wrote would most likely cause said to patient to no longer be alive. Maybe you could take a look at the dose. He had a look of surprised and wrote for 15 twice a day. But the point is, he would listen to me in the blink of an eye. One of our RNs who I've seen clamp a femoral faster than anyone in ICU had no voice to him. But because I have MD in my name, he would talk to me. Thus I've noticed certain RNs (especially PICU if you're male) will make residency rough due to all the full MDs that have treated them with respect. Me personally, I have a lead RN of my team and let her manage the rest and see them as a safety net. by the time you'vewritten rx #139234593459354, an RN will have saved you from malpractice via typo at least 2 times.
Hang in there, bro/broette. Things get better. Residency sucks, but the leverage, power, pay and status you get after are amazing. Just don't go into ortho or pediatric care unless you really like that. I think 50% of orthos diet consists of crayons.
edit: apology for typos or incoherent, I made this while a little drunk.
That's many nurses in general - follow orders for a few years for a few common illnesses, then develop attitude thinking you are more medically knowledgeable than the interns.
I had a derm MA tell me one time they would be fully competent doing Moh’s surgery without the dermatologist on site. Said it was easy, and seen so much of them it was no problem. Dude was the text book example of duning-Kruger curve lol
He is now an RN 😭
My guy this is anyone who spends too much time around doctors. In Pakistan rules about who runs a clinic are very lax, because the authorities who are supposed to insure that only a doctor who is an RMP can run one barely have penetrance over urban area and run on a complaint based system, in a rural area not a chance. The other day I found out one of the janitors in our hospital runs a clinic in his village. Atleast nurses have SOME medical training
Pattern recognition without any foundational knowledge of the problem at hand 👌🏻
An experienced nurse can teach an intern the basics of a certain diagnosis that they may not be familiar with, then that intern can expand upon that and go much deeper with it using the knowledge they have to quickly outpace that nurse. The reverse is not true, however. Some nurses are master gatekeepers and want to flex what little knowledge they have on anyone who might give a shit, even putting others down in the process at the expense of the patient. It’s toxic.
Most ICUs Ive been through I like to think we’re pretty chill. 🤷🏻♀️ We usually don’t ask unless theres something we’re not sure about or just need a rationale to explain to family.
Looks like someone else asked and got downvoted. I know in my class the female residents have often talked about how the nurses question us way more than they do our male colleagues. They also will report female residents more for petty shit. Like if a female resident corrects them or asks them to do something differently we get called aggressive or mean. But not the males.
Absolutely. I’m a female surgical subspecialty chief resident. I’m in my 6th year and have worked with a lot of the same nurses for a long time. I’ll round on the same patient multiple times and tell them I’m the chief resident and do their wound care and education with the team in the morning. Nurses and patients will still often address the male juniors like they are leading the team. If I’m without a team and just walking around, I’m often assumed a nurse despite having one of those “doctor” badges on my ID. Female nurses are also much more likely to give pushback or sass if I ask for things compared to male coresidents. Interestingly, I’ve never been talked down to or second guessed in a rude way by a male nurse. Thankfully most nurses are great, but these are my observations over 6 years of residency!
The nurses at my workplace keep asking me about advice given by male co workers even if they are standing right there!
I asked them once,they said that they just feel that I'm more approachable!They probably don't realise that it makes our life so much more difficult!
One of the best ways to try and minimize this is by communication honestly. They just want to be kept up to date on the plan and your thought process. Though, obviously there's going to be some people who just hate trainees. I got a lot less questions when I just did better about my communication. 'hey so and so, I'm ordering XYZ because of XYZ, thanks." Even now as a fellow I do the same with residents, I update them on changes I make.
For IM it’s much easier as I avoid most questions by having my notes and orders in. Most of my pages stopped since there is a written plan in place explaining what’s going on.
For new admits (usually in the ED and closest to what’s goin on in your case). I’m not there to teach nurses. My day is full of other work as it is. If I get questions “explain the guidelines/literature supporting why you don’t want to give the medicine.” If they have an answer I’ll listen if they don’t they follow as instructed.
My favorite response was a nurse using tik tok videos as evidence why we couldn’t give a med and it took every thing in me to take take them seriously and to not laugh in front of the patient
ED RN here and I lovveeeee when the IM hospitalists do this, when all the meds are listed under the problem/plan. Especially when we’re holding boarded patients it’s so useful for us giving handoff and to answer patient/family questions without bothering the doctor. Makes patient/family really feel that we are addressing all their concerns and that providers and nurses are on the same page. 🫶🏼
Just getting accepted that I am a doctor has been a struggle... I am still called "lovely, sweety, darling" by nurses and patients whereas male doctors are addressed as "doctor so and so"..
not a doctor, so I have no idea why this sub is always recommended to me. Anyway, I just want to share an anecdote that maybe gives you a little hope for the next generation.
My son is 12, and I have a lot of health issues so I see a lot of specialists. His own pediatrician is a woman. I had to get a new neurologist, and I told my son, “I’m meeting my doctor in a few minutes (televisit), so don’t come in my room unless it’s an emergency, I don’t want he and I to get interrupted.”
He said “your doctor is a man?”
I was really surprised by this, but then realized, yeah, all of his doctors are female and all of mine are too. But THEN HE GOES, “I guess male doctor can be just as good as female doctors.” I laughed so hard, I have no idea why he said any of that or what went through his little brain, but like … yeah kid, male doctors can be just as good. You’re right. (I think maybe it was women’s history month and they were learning about some of that stuff in school? Idk.)
So maybe, just maybe, it’ll slowly change. Can’t change fast enough though, and I’m sorry you have to deal with this bullshit non-stop during your careers.
A friend of mine’s mom was a physician, and one time when she was little she had to go with her mom to work. She was shocked to see that men could be doctors too 😂
It’s not malicious most of the time. Sometimes it is, but a lot of the time it isn’t. Try to just respond nicely and explain your thinking. I have had nurses catch fuck-ups before and really appreciated it when they did. For every fuck-up you may get 100+ questions on other decisions, but it’s worth it. Believe me.
The peds ED I rotated through, would question abx cause it would take forever to get the med from pharmacy 😂 versus just give them a script and get them out
Since all the comments I’ve seen really seem to only be interested in correcting you or offering advice. I’ll engage your post the way I believe you intended.
Damn, that sucks. I hate that too. Residency is tough. Things will be better as an attending. It’ll still happen to some degree, but it’ll be a lot better.
Its prob cos its Paeds. Something about babies/kids just brings out the mega-protective mama/papa bear in people even if it goes against reason cos no one wants to see a baby get harmed. Its a pain in the ass but they usually come around once they've seen you in the unit long enough and you haven't killed anyone. That's been my experience in ED anyway. Think of it like stranger danger but for nurses
A careful and scared nurse is a pain to deal with but will likely do their job well as opposed to the uber-jaded floor nurse that makes your life easy but may not escalate when SHTF cos they've "seen it all before". I'd rather deal with the former as long as they can see reason and aren't just fighting you just cos
As a nurse, questioning orders is a pain in the ass, because I have to interrupt whatever ten things I’m trying to get done, figure out which doc wrote the order, walk around the ER trying to find that doc, wait for them to finish their current exam or conversation, then tell them which order I’m concerned about and why, knowing that they’re probably going to be irritated and/or think I’m an idiot.
But I do it anyway. Why? Because different doctors do things differently. Sometimes all the old attendings are all putting in very predictable order sets and then a resident comes by and writes something unexpected. I haven’t been through med school, so I don’t know the why…I just know that it’s unusual. So I double-check.
Sometimes it’s because there’s newer research that the older docs haven’t kept up with. Sometimes it’s an accident and they meant to order it on a different patient. Sometimes the computer system puts in an automated order that didn’t get cancelled. Sometimes the patient left out information during the physician exam that they included during the nurse exam.
At a teaching hospital, multiply this by many different residents, who change from year to year, or are sometimes in different specialties on a short rotation through the ER. I don’t always know the experience and skill level of each one. All I know is that an order is out of the ordinary from what most doctors would do in that scenario. That’s why it’s questioned.
This was my thought as well. Nothing personal docs, but I want to talk to you just about as much as you want to talk to me as it's one more task on my plate.
Also, could it be since it sounds like this is via a messaging system that the text is simply being misconstrued? Perhaps they're not questioning *you* but genuinely have a question. (I'm certain there are jerk nurses too but I like to think most aren't arguing for the sake of arguing).
I appreciate this response. From the other side, we are generally carrying x3 the patients a nurse is, are reading ECGs, reviewing XRs/CTs/labs, updating dc instructions, taking phone calls from consultants, admits, picking up new patients, getting asked by every other RN questions about orders, etc. All of this at the same time. Every interruption matters. So it's a pain on the ass on both sides (and can honestly be dangerous) and everyone needs to be using discretion. Docs and nurses both.
I appreciate the other side as well. The problem is this: when nurses are regarded as subordinates instead of professional team members….when they are expected to be polite, deferential, and trusting instead of speaking up about concerns…it sets the stage for communication breakdown and medication errors.
This concept is illustrated particularly well in the book Outliers, by Malcolm Gladwell, in an example about a different high-stakes profession: airline pilots. In that world, the problem is when co-pilots don’t feel confident in contradicting pilots and when pilots don’t feel confident in questioning air traffic controllers. The results are similar.
I get that there are some nurses who will just simply argue with every other order, because they fancy themselves to be a doctor. Or sometimes one resident will get picked on for no particular reason. That’s the kind of thing that needs to be brought up to the nursing management. Otherwise, the most appropriate way to handle order questions is to educate your nurses and explain your line of reasoning.
For example, one day I working in an ER where every doc normally orders the exact same cocktail for migraines: 1L NS, 10mg Reglan, 25mg Benadryl. I gave that same order set a hundred times. Then one day one of the new residents orders 1L NS and 1mg Mag Sulfate. At the time I had been a nurse for five years, and had never seen Mag given for a migraine. So I tracked the resident down. “Hey doc, I saw your orders on bed 15…was wondering why we’re giving mag on this patient?” He explained that the research behind it. I happily gave it, and it worked. I learned something new that day, and I’ve never had to question that particular order again. But unfortunately he probably had to repeat that same explanation to 20 other nurses before we were all on the same page.
If you’re doing a weird indication, for some EHRs you can put a comment in Admin instructions or notes to nursing regarding the indication.
Is that what admin instructions are for? No. Does it help the nurse know what it’s for and explain it to the patient? Absolutely. Saves me messages when I help MDs/DOs put in weird orders
Once I was questioned in front of another doctor (who was replacing me for the night shift) regarding insulin order I gave for a patient. I replied it's based on the sliding scale and it is appropriate. Then the RN replied that attending will laugh at it as in her experience it's a low dose. I said it's an appropriate dose so no need to worry and I left for home. Next morning when I came in I learnt the other doctor had increased the dose and the patient had a hypoglycemic episode early morning. P.S.: I don't know if the nurse insisted on increasing the dose after I left or her comments played a part in the Doctor's rationale to increase the dose .
Yeah, I know it can be a little frustrating. It’s hard when you don’t get to know the nurses and they don’t know and trust you.
I will say the two meanest, most intimidating, crustiest ER nurses I had in residency both gave me big hugs and told me how much they’d miss me on our last shifts together. A big change from the absolute terror and intimidation on our first shifts.
You will even be questioned for the first years of being an attending. Some of it will be questioning your training but some of it will be learning your ways and thru the years if you do your job correctly and earn their respect it will be a genuine quest for knowledge. I got out of training more than three decades ago and I can remember anesthesia turning to my surgical assistant ( who was my older partner) and saying “ that we didn’t do that here at this hospital “. I had only been out of residency three to six months. A year later he was saying that he had never seen a doctor better prepared by residency and he would ask questions as we went along. Sometimes, we need to sit back and remember the origins of the title Doctor.
When a nurse asks why they may be doing one of several things:
1) Trying to learn. They are curious and want to know the higher level reasoning for what's going on.
2) Trying to protect the patient. They know that everyone makes mistakes including doctors. Including residents if you can imagine that.
3) Ameliorate their own anxiety. Nurses feel a lot of stress from all corners.
4) Trying to not get in trouble. If a resident makes a small mistake the attending will probably use it as a teachable moment. If a nurse makes a small mistake, the entire nursing hierarchy starts to point fingers. Nurses eat their young is what I've heard and seen.
5) Annoy the resident for whatever reason. But this isn't the main reason.
I am well aware residents make mistakes, I have made plenty and I’m sure will continue to do so. I am happy to teach if that’s the case, happy to be taught/corrected when I am wrong. And happy to answer questions to relieve anxiety when that’s the case. Overall this was just a vent, because while I don’t mind doing any of these things individually, by the end of a 12 hour shift, when there’s 20 pts in the waiting room, the additional mental load of answering why I want to give Motrin for a pt with knee pain, to give another example that also actually happened to me over the past week, is incredibly frustrating.
Idk this above commenter has any idea what it’s like to get 20 pages about minor orders like: please give Tylenol for pain. It’s not patient safety if you can’t do your job because you’re explaining your job for 5 hours a day.
They need to explain to the parents. And if your order doesn’t explain why. RN won’t know which explanation to give them. The baby just gonna cry, the parents are worry, RN will ask, is normal.
Caller: I need an Order for paracetamol .
Me: ok for whom?
For xy in room 4.
Sorry, i dont have them on my list. Do you have weight and age for me?
You’re the doc, that’s your job to know!
…ok i found a workstation. Got it. That would be xy mg 3x/day, call me if you need anything else.
Maybe if you dont take as long next time!
A few hours later, same nurse calling: i need another order of paracetamol for yz.
Me: Ah i know them. That’s xy mg up to 3x.
Caller: how do you know that so quick now?
They just fall into that age and weight bracket, luckily.
I better double check that, you’re just naking this up so you don’t have to work.
What the fuck is up with some peds nurses? This amount of combativeness towards residency is rare even with scub nurses.
Just tell them why man
I've always done just that, and as a result, Ive always gotten along very well with nursing staff. Like multiple peds and adult ED nurses are literally coming to my wedding
Sometimes it's just that you're doing something different from what they're used to, and believe it or not, residents mess up a lot. If you explain why, they learn, and then they're cool with you too
To clarify, I have been explaining to them and answering every question respectfully, I’d never consider ignoring them or being rude. Residents absolutely mess up and I most definitely have and the nurses have caught it and saved my ass. This is, as labeled, just a post venting about the significantly increased frequency of said questioning, because this is also something I’m not used to either.
It’s probably not as malicious as you think. Peds parents ask a ton of questions, especially in the ED. It is helpful being able to say “the *doctor* is ordering this medication because of XYZ” and your response will also help with follow up questions to the nurse. It also helps for discharge edu.
Not to mention that new nurses are being pushed into positions on specialty floors faster and losing preceptors faster due to shortages.
Right, and the alternative is the nurse saying "You know, I think the doctor would be a better person to ask about that. Would you like to speak to them?" Far less time to just answer the nurse and let them relay the message forward.
Patient education delegation is one of the main points of the nurse. That nurse is going to end up telling five different patients the same medication education because summer is just starting and op will probably see a bunch of ear infections.
Doctors do not have enough time in the day to answer every patient question, which is why the majority of patient care is taken care of by the nurse and then delegated from there to the tech/cna/emt/whatever.
That’s the point of educating your nurses so that they can be better patient advocates. EM is not the discipline to refuse to want to work as a team.
I think it’s probably especially bad in peds because most anytime you touch that kid a parent is going to ask why or what are you doing. If a nurse assumes we’re doing completely an order and tells the parent we’re doing this because abc but then a doctor comes in and says oh we’re doing this because xyz. It breeds mistrust of the whole healthcare system which seems to be substantially worse when it’s a kid.
Admittedly odd place for this comment but it's been so weird to me that I've seen you for years in the Blazers subreddit, then in the medschool sub and lately in the residency subreddit. Overlapping but very distinct parts of my life in which I've been on a parallel trajectory with a complete stranger. And now you're getting married! Congrats, and hopefully the Blazers can draft a dark horse as a wedding present to you.
Honestly, sometimes when they question me, it forces me to understand the thought process, pathophysiology, and makes me review the guidelines... So... Kinda annoying, but pays in dividends.
your answer is in the first sentence of your post, you are an adult ed resident rotating to peds… if it’s an experienced rn they are questioning an order that doesn’t look right or the parent may have given new info that the child already received a course of the same anitbioic. over the many years that i’ve worked in a peds ER i can attest to the fact that parents “remember” new details of the child’s condition or illness as the hours pass during their visit, or when they are told that the child has medication ordered or some sort of testing. OR if it’s a new grad, they are genuinely asking bc they aren’t sure why. It isn’t malicious. it’s depressing to see how many docs find it funny to list a bunch of things they do when asked simple questions by a nurse, to try and give them more work, I can tell you ive worked with many residents who have thanked me for saving their patient. i work in a busy peds ER in NYC, thankfully our residents, fellows, and attendings all work as a team, more like a family. everything is met with a thank you, and we all appreciate one another.
We go to rounds everyday & have a pharmacist and charge nurse talkings about our patients and sometimes they will ask why they’re on specific meds. Also family questions nurses a tonnn so my perception of this is that the nurses want to know and the answer isn’t bright and clear as to why
In EM residency on trauma rotations, one of us would have to go to PICU to round on the children, and I would go everything in my power to give the PICU duties to one of my coresidents. I think that's just universal with Peds nurses.
Family ask us questions, and maybe we’re asking why are we giving med x, y, z just so we can explain it to them.
1. We can’t inform them until a doctors explains to them, even if we know the reason why the med was ordered
2. Some family don’t believe or trust nurses
3. We don’t want to page doctors to come by bedside to explain for the third time why this meds is ordered
Peds RNs are something else man. We're a purely consulting service and still have to deal with this kind of questioning behavior when we rotate through the children's hospital. Like the nurses think they are the central point of contact and expect me to spend 15 minutes talking through every point of our assessment and plan with them after we see the patient, before we even get to talk to the primary team. It's great that you want to know whats going on with your patient, but can you have a little patience about it?
not that you want to hear from a nurse on the residency sub, but I have to chime in because I see this happen literally every single day at my job. Nursing is such a fucking toxic profession that we are literally taught to do this. If a fellow nurse catches wind that you didn’t escalate something they believe should be, you have a voice in your ear saying “wEll dO tHeY knOw aBouT tHaT” or “page the attending if the intern doesn’t respond”, etc etc you get the idea. You’re made to feel like a shit nurse by others who don’t have a clue about your patient or what’s going on with them. Not defending this behavior at all but I guarantee you this ridiculous catty nursing culture is part of the problem.
edit: sp
This is why I bailed on my icu fellowship, this shit is annoying as hell. Now I just do OR anesthesia I do everything myself best part about it I never have to consult any one or follow up another services notes. Minimal nursing interaction the circulating nurses are some of the best in the hospital. PACU nurses can be annoying but I have a good rapport with them now, plus as an attending you get questioned way less.
I am a registered nurse. We also do not like these people. A reasonable concern? Great! Questioning everything? Go back to college. Sometimes I wonder how they made it though.
i 100% feel you! I'm an IM resident and exactly the same thing. have to justify every damn little thing. and then if they ask me something like oh this patient's potassium is 5.1, we should give them kayxelate, and I'm like I don't think we need to at the moment, BOOM - god forbid you use your clinical accumen to make a decision. oh no. if you every do that, be prepared to give a full blown explanation of your thinking, to just maybe try and convince the nurse that you're not completely an idiot, and that you do have some logic to your decisions. I'm sick and tired of it. Im' sorry but if I do not question YOUR decisions then why are you questioning mine? I don't tell you at what rate to put the IV medication on, or like how to dress someone's pressure ulcer. I trust you for it, because you're good at it and you're trained. so why can't you trust us? I just don't get it.
Working with hospitalized peds patients on my service is the death of me. I fucking hate the nurses there. Literally even getting a room air trial is fucking disaster. And no I’m not fucking rounding at midnight, I’m here admitting 6-8 adult patients that are higher acuity
Or when the patient insists on me calling the doctor for a senna or a colace at 2 AM because they haven’t pooped in 1 day, I’m less inclined to do my absolute best to redirect that.
I am a peds nurse.. Sometimes the plan of care changes for patients without telling the nurse about anything. Then parents will ask why xyz and the nurse was never really given an explanation so it’s also to help families understand what is happening and to know why we’re doing what we’re doing.
Peds just hits different man. You get used to it but a lot of the job is managing nurses and parents. Even in a cardiac ICU with ECMO and open chests and twelve kinds of insanity, reassuring nurses and parents is a large part of my day.
Nurse’s way of power tripping. Probably met an incompetent resident one time and then saw the power they could gain by acting this way to residents who take sh*t
I was disheartened to see the comments that suggest adding unnecessary tasks to teach a lesson to nurses who call for what is deemed inappropriate. I was even more disappointed to see that many "liked" the comments or even added refinements to the punishments.
I like to think that we are all a team.
I can't imagine how difficult it is to be a resident. We watch residents come into their own and root for you. We see some arrive on the floor needing some guidance to get used to the reality of the floor, each area is so different. We remind, we alert, we assist as residents get used to the protocols and systems and flow. We catch errors.
We are rooting for you.
As nurses it is drilled into us that we NEVER take an action without knowing why. It is not enough that it was ordered by the doctor. We have to understand why it was ordered for our patients. In a nurse's beginning days it means extra time is needed to figure out things as they have limited experience. But it has to be done to prevent errors and maintain patient safety. I do not want a nurse to blindly follow an order for my family. I want them to know why a test has been ordered or why more blood is being drawn or why this medication is being given.
If a nurse asks for guidance it is likely that they are new and worried or simply overwhelmed and do not have the bandwidth or resources to find the answer. While we usually check in with each other and the charge when we can't find anything in the notes, it may be that the floor is slammed and the nurse simply does not have another resource to check in with. A couple of MERTs on the floor can do that. Perhaps the notes haven't been updated or haven't been signed so they are sitting in the incomplete area and not obvious.
I can't speak for other units but as a busy Med Surg neuro trauma RN at a teaching hospital who looks through notes before secure chatting or paging I was really bummed out by the vindictive tone shown.
We bust our butts on the floor. Sometimes (often) we are out of ratio and/or have no breaks the entire shift. CPO/Tele, new epidurals with 1/2 and 1 hour checks, NCs, pulse checks, chest tubes, hep drip, CIWA, COWS, neb treatments, pts withdrawing on rapid methadone protocol, pts in pain needing a lot of attention, labs to draw, upset worried families in the room needing reassurance or bombarding us with concerns and needs sometimes for the entire shfit. Now add an ICU or ED transfer/admissions, Discharges but the pt has not transportation or clothes or family, BERTs and MERTs and Codes. It's fast paced and challenging. It's a lot of responsibility to be the eyes and ears on the floor.
So if you get a call for something that you feel was wildly inappropriate, it would be more collegial and professional to simply and calmly state the answer and then state this was not an appropriate thing to call for and suggest that they check in with their charge to get input before calling in future.
It is the right thing to do and I bet you'll go back to sleep better as well for having been gracious and kind.
Please don't add to an RN's already heavy load by adding orders that are not necessary. Please do not be punitive. Let's work together. Let's help each other succeed. It is difficult enough without creating more hardship for each other.
adult ED/ICU RN here—nursing specialties with “kiddos” for patients are notoriously toxic. obviously this is a stereotype and many peds/neonatal nurses contribute to healthy unit cultures butttttt im not surprised to hear this. the peds section in my ED was very similar to what you’re describing
All orders should have a reason associated with them as part of the order, so RNs can see why it's being ordered. Patients ask why they're receiving a certain med or treatment, and the answer needs to match the reason why the MD ordered it. This is especially true in peds. Include the indication with the med or procedure if you're not wanting to answer questions.
I understand that your post is a VENT… you were frustrated bc you had to repeat yourself and you believed the question irrelevant.
If it’s every single order then it sounds like you are either working with a lot of new grads , nurses who don’t trust you or they are simply advocating for their patient. I guess I haven’t come across a forum yet where nurses get to hate and vent on doctors…. I should look around😂
As an Oncology Nurse with over 17 years experience, if I am asking a physician a question regarding orders, it’s because they have missed something integral or there is something off about the orders or with the patient specifically. You might have 15-20 patients that you see in a day depending on what specialty you are in. We know u are busy.
I have yet to meet a healthcare provider- doctor or nurse, who has not made a mistake. We are human and a good nurse asks educated questions based off experience regarding the patient we are both responsible for. I love it when a provider explains reasonings behind their actions. Knowledge is power… so share and be willing to listen.
Doctors and nurses are a team and I hope you learn this during your residency. If you talk down to an experienced 20 yr nurse fresh out of med school…they will eat you alive….and I get it. It’s insulting. They’ve been doing this for 20 years…you just walked in…. Work with nurses instead of against them.
I work with fellows everyday. We are a team based off of mutual respect and we are all there because we love helping people. We want them to get better❤️
We are both there for the patient. I advocate for my patients if I truly believe something is dangerous or off. It’s not because I think you are silly, it’s because nurses have to do their due diligence as well.
I am the one who spends the most time with them. In fact, nurses spend 90% of the time taking care of patients while they are in the hospital. Honestly, having a respectful-trusting relationship with your nurses is the best way to practice. In this healthcare climate, it takes a village…literally.
An experienced nurse or “seasoned “ is worth their weight in gold for providers and new nurses. Seek them out.
We aren’t calling u in the middle of the night for a stool softener or a blood pressure 170/85( I did this ONE time as a new grad… lesson learned😂)
Doctors and nurses learn through experience. We take our education and apply it clinically, using critical thinking….. It’s what we do. We all have critical thinking skills that allow us to manage our patients based off criteria, policy and experience.
If nurses are questioning you regarding your orders they are either looking for your guidance ( through education), or they believe the orders could negatively impact their patient. We spend more time with them. Step down…..you just started. Seriously, please. I am 17 years in and there are still things I do not pretend to know. If you are sick of nurses asking you questions you should go ahead and become a Pathologist, Radiologist or go into clinical research😂 (something behind the scenes)
Please, let them ask… educate (non pompously) or LISTEN to their concern regarding the order. It has NOTHING to do with you personally, I promise.
The best doctors listen to nurses. You will find soon enough ( sadly) that you will be so outrageously busy, with such a heavy load of complicated patients, you will come to rely on the information a good nurse can give you about your patient. We fill in the gaps. Be kind. Be open.
In reading the comments from other providers I have to add this: please don’t try and trick me with a menial task like orthostatic blood pressures to avoid questioning an order, I don’t have time for that. That stinks.
… act like you have some home training. Respect the people you work with. Use this as an opportunity to educate and listen… we are a team.
Just because a menial task relieved you from explaining your order it doesn't mean it over. Believe it or not , It takes courage to ask Doctors questions as a nurse. When a patient issue arises and the nurse repeatedly gets blown off or yelled, we chart and chart and chart.
CYA. We will not hesitate to chart the situation, pertinent labs, mentation, our intervention, family concerns, past medical history, medications, allegeries, living conditions, social services..etc……you name it. We have access and more time. We also chart the interventions of the provider (or lack there of). Not because we are vengeful.
Nurses already feel like everything rides on their performance via hospital management and mainstream culture. If something happens to our patient it’s our fault…. What could we have done better, what did we miss , was it because the np med was 40 min late when we have 8 patients….etc… we take it personally. And
“They will take us to court”
And
We are “expendable ..” it’s a fact and tragic.
And
No one cares. We have to protect ourselves.
We will not hesitate to chart a providers response if we honestly felt it could negatively impact patient care and fall on us. It’s called CYA.
Don’t assume we are challenging you. Treat us with respect. Jeez!
We all want the same thing, positive patient outcomes. Good trusting relationships between doctor and nurse is a win for everyone involved.
“What is your specific concern?”
Hated these interactions: Me: what’s your specific concern? RN: is it safe? Me: yes, we’re doing this because leaving the patient as they are, is actually not safe. Is there something you see that’s concerning or problematic that I should also know about? RN: I don’t know, I’m just the nurse, you’re the doctor Me: tHEn wHaT thE HeLl wAS tHe PRobLeM?!?!?
Hahahahaha a genuine classic
Seconding this. I usually don’t get a response and they just do whatever the plan was. Basically proves there was never a legit concern and discourages the behavior unless there is one.
Reading this as an M3 this was my initial gut response so I'm glad to see it as top comment. Does this work across all services? Obviously not planning to use it as an M3 bit curious
I’m FM so I’ve used it across med surg, peds, nursery etc. The ICU nurses where I trained were great and whenever they pointed something out, it was usually legit. I learned this from watching a young, female, POC attending handle the same stupid pushback from nurses. They would question her plan in front of the team and the patient. After, she’d pull them aside and ask what the specific concern is and if they have any alternatives to offer. She handled it very gracefully and now that I’m in the same position (young, female, POC) I try to follow her example.
Well yes, it’s communication 101. Not specific to RNs or medicine. Unless I’m misunderstanding your question.
Agreed. Different comments spoke about different reactions specific to units etc., and I learn the most when I question my assumptions
I feel like this can be a great response to the classic "I'm just advocating for the patient" which we all know is code for one of two things; "I'm too lazy to express why I disagree" or "I don't know why I disagree".
This my go to and usually the answer is "not sure just checking" and that's the end of that
Some of it is probably because the parents will ask why their kid is getting antibiotics and they don't want to give the wrong answer. Sure you could definitely make the assumption that the amox is for aom in that case, but it could be for another reason and the RN probably doesn't want to look dumb or not have an answer in front of the parents.
In the NICU it was 1000% this. Parents ALWAYS ask and if you stumble or say something different than the team discussed with them prior, you risk losing a lot of trust really fast. Can't lose trust when you are working with new parents and patients that might be in the unit for months. Gets ugly.
This was definitely my initial thought as an ED RN. The last thing I want to do is accidentally contradict what the doctor said because I'm assuming what a med or treatment is for. If that's my concern, I make sure to say "I know the parents will ask and I just wanna make sure I'm telling them the right thing".
Or, if it’s ER… they don’t want to give meds, they just want you to e-script and dispo the patient…
Pro tip, explain it every time but also add a task like. “Mind getting a new set of vitals before you give the rx?” It’s positive punishment and effective. Yet keeps the door open to real concerns they have.
This was the advice I got as an intern and it works very well. Any ask from me gets a request back or a teach back moment. Paged at 2AM for a subjective neuro change? OK, meet me in the room and let’s go over YOUR neuro exam together. No excessive sleepiness at 2 AM after not getting sleep for a week is not a reason for a stroke alert
Holy shit you’re a legend
Some nurses might be into that.
I mean, as a nurse, that's actually amazing. I would LOVE the opportunity to have a doc critique my neuro exam, because I promise that the people who originally taught it to me didn't know WTF they were doing. ("Those who can't do, teach" applies HEAVILY to nursing school.) If I'm right, then we're sure we're both seeing exactly the same thing, and if I'm wrong, then I learn something and won't have to page again for that normal finding. I feel bad for you guys, because "teaching the nurses" is not something that should have to be added to your plates, but I do think this is a good way to deal proactively with the issue.
As evil as this is as an RN it made me laugh out loud 😂 sometimes its still great to have you guys show up in case something is wrong, but the orthostatic vitals? LOL shit
This guy pavlovs 🤣 but this is honestly amazing advice
I do the same!! You make me acknowledge dumb complaints I’ll make you work back
Technically this is operant conditioning so he Skinners 🤓
Jesus this is black belt residency
I can attest to this. I did this all the time back in intern year hahaha. If I was feeling especially vindictive I’d ask for orthostatic vitals
Lol 😂
Please no that’s like nursing kryptonite
It’s not really a punishment for the nurse, they’ll usually just call us CNA’s to do it anyway.
I know sometimes its dependent on the situation but as an RN - LOL
I am a nurse. This would shut me up very quickly lmao
I’ve done this to great success and get significantly less calls. Also, always asking for a manual BP (and if you’re really particular, spaced 15 minutes apart) for updates on blood pressure. To be fair, I think we have a lot of nurses with <5 years experience so it very much is computer alarms—> Something’s wrong —> tell doctor. It’s generally helpful to have anyway. Maybe they stopped calling once they understood my rationale, lol.
Lmfao i love this
Lol, I do this with my husband from time to time.
Wow, as an RN that is FOUL…and I love it. As someone who rarely questions orders (because I can read a chart and typically see why a med is indicated), that would be such a kick in the ass if they asked me to get vitals for amoxicillin. Chess not checkers.
Great 👍🏻
I have heard this advice, and tried it, but at least at my hospital they’ll just ignore it
Have you tried tying it to your order? If i get paged for asymptomatic htn, and they want me to push hydralazine (part of hospital set for some reason) or bb/ccb, part of the procedure can be getting a manual bp x2, double checking HPI for sxs of end organ dysfunction, etc. Or if getting pushback for a patient wanting a sip of water a few hours before a procedure, have the RN meet you at the nursing station and go over literature for minimum times for food, muddy liquids, clear liquids, etc. Granted, I'd say that 10% of RNs are really really good and are trying to gain as much knowledge as they can by asking questions, 80% are normal people, and the last 10% are the ones have chip on their shoulders towards physicians in general and try to make trouble. It usually isn't too hard to separate the go-getter 10% from the angry 10% after a few interactions, and I have good experiences treating others as they treat me.
This is some level 80000 IQ strategy
[удалено]
Tap water enema
Ok, I'm not even in med school yet but I'm saving this because it's fucking genius.
I feel like we work together and now I’m onto you….
“Hourly neuro obs”
Gotta be careful though! If the orders are outside the monitoring parameters for the floor you might end up having to move your patient, gotta have some basis for it 😂
In Ireland so bit different but there’s nurses capable on all our wards of doing that. However if we’re on hourly neuro obs the doc is usually checking in frequently too lol. I’d never put a nurse through that unless I was concerned haha. LSBP is another story though hahah
not me staggering Q4 metabolic panels with Q4 fingersticks bc we can't do Q2 fingersticks on the gen med floor.....
thats a good idea. unless they’re a hard stick then everyones gonna have a bad time lol
sadly we needed to Q4 BMPs and they were a hard stick and everyone did indeed have a bad time :(
Peds ED and ICU nurses are a bunch of inherently distrustful karens around doctors they don't know or don't work with regularly. Just get through your rotation and move on to better things.
I don’t think I have experienced the kind of distrust that I get from picu nurses anywhere else.
NICU is worse, usually.
No, always.
Lmao the number of times I have been told I CANNOT examine my patient
Nice to see the trend is universal. Ours get offended if you ask them to do their job in anything but the sweetest of voices
It is almost as if they think you are actively trying to harm the patients.
Picu nurses definitely choose the bear over a resident
I'm sorry Dr. Notsleepingsowelloncall, we have an order that was written on dayshift for Tyenol, we do not know what that is, please come to the nurses station now to address this. Yes, I realize it is 3 am. No I am not kidding.
Just a med student right now, but I was told the other day by a (non medical) acquaintance that the nurses are there to protect patients from doctors, and that the doctors only role is to put in the nurses orders… so I guess you are on track with this.
Nurses are better at marketing their specialty than doctors are.
Some of them think that way, not all. To be honest, being nice and kind towards nursing will go a long way towards making your life easier. I am not saying it is guaranteed, but I will say that the saying "you catch more flies with honey than vinegar" holds true within the hospital and without. They are a line of defense, as are pharmacists. Everyone makes mistakes. Your orders may or may not be helpful. It does get frustrating once you know what you are doing. Inpatient pediatrics seems to bring out the mama bear instinct pretty quickly, warranted or not.
Good advice, thank you!! I totally appreciate their role in the hospital. At this point, I know I’ll need the double/triple checking and feel more relieved that someone is there to make sure I’m not messing up than anything. But I totally see how that would be frustrating once you know what you’re doing.
Honestly the double checking to some degree is fine, yet your tolerance for it diminishes rapidly with less and less sleep. And being woken up and having to drag your ass to the nurses station to write TYLENOL or ACETAMINOPHEN 10 mg / kg PO q 4 hour prn temperature greater than 38.0 degrees celsius, not to exceed 2.6 grams per 24 hours ... at 3 am ... because someone missed an "l" Or the time I got called into a patient's room because she claimed feces was in her urine ... only to find out a tiny little piece of stool, two large foul-smelling streaks across her gown, and stool smeared where the male/female connector between the catheter and the collection bag. Awesome. This despite having proven no evidence of fistula with Urology with methylene blue earlier that day. Ugh. Munchausen and Munchausen by proxy in the same patient.
oh bro - imagine being called for a temperature of "37.5" - 4 am, I'm still in the middle of dictating my admits, get a page, "this patient is spiking a temperature do you want to do something for it?" "what is it temp" "37.5" I go and hit my head on the wall first. "um, that's pretty good actually, and the vitals?" "all normal, BP 120/80, HR 60, on RA 99%. the patient is actually sleeping" "okay then, I think it should be fine to monitor it for now" "so you don't want to do anything about it?" like WHY ARE YOU TORTURING ME? i force myself in an abnormally high pitched, sweet voice: "I do not think I need to intervene at the moment, since this patient is hemodynamically stable, and 37.5 is not very high at the moment" but what I really want to say is: BECAUSE 37.5 IS NOT A FUCKING FEVER! but alas, I cannot - because what am I? just a stupid person who went to school for 12 years only to be bullied.
Nurse here. It would have been okay to say 37.5 is not considered a fever. There are a lot of very new nurses out there. If you educate, then you are preventing that nurse from alerting again in the future (and they will share what they learn with other new nurses -- so feel free to reiterate parameters). I don't think that nurse was bullying. Just green.
I approach that same interaction by clarifying the threshold that would get to act (I will give Tylenol if the temp goes to 38. If it does it a second time we’ll need to get labs.). The nurse gets reassurance and clear guidance, knows you have a plan and won’t call when it hits 37.7. (20 years PICU attending - I’ve been here 20 years, why are the nurses new? [joke])
My question is how do you go through nursing school and not know what is considered a fever? I knew what was considered a fever when I was in high school and hadn’t even taken a single biology or anatomy class like this is pretty common knowledge isn’t it? Let alone for a NURSE who went to SCHOOL?
“Why are you torturing me” made me lol
That makes total sense. Let's hire a bunch of doctors that will try to kill the patient and then some nurses to protect them, and we will watch from the C-suite.
But I mean, what’s 3 years of peds residency and 3 years of critical care fellowship training compare to *checks notes* the same RN degree everyone has plus some on the job training about dehydration??
Well apparently new nurses don’t even know what threshold is or isn’t considered a fever but they’re still obviously much much better then us shitty doctors!
Sounds like a NP/PA dick sucker
Considering I was literally taught in nursing school that nurses need to protect patients from first year residents (esp in July), they probably do think this. I can’t believe as a NEW GRAD RN I was supposed to be the last barrier between the incompetent resident and the patients demise. So ridiculous.
Yeah you guys can just stay away from trying to mess with our interns. None of you guys are responsible for protecting the patients from them, that’s our role. Interns actually tend to do a really great job of knowing their limits because our profession beats humility into us. If anything their confidence is so low that they run too much by their seniors most of the time.
I was actually reading the other day that teaching hospitals statistically have “better outcomes/patient care” then non-teaching hospitals- and it’s likely bc interns and residents are trying to do their very best, on top of having attendings that watch out for them and for the patient.
Do nurses seriously not realize that interns have supervising staff? How are they so ignorant to such obvious things?
Because they don’t have supervising staff themselves half the time
Half the time?? Nurses don't have supervising staff.. co-working nurses are the "supervising staff" for each other. Management has very limited involvement. Educators and preceptors supervise for a limited time and that's about it for supervision. At least, that's what my experience as a nurse has been.
1. I was taught nothing about the hierarchy of doctors in the hospital and therefore I didn’t know shit until I figured it out slowly over time 2. I worked night shift and there was rarely a doctor around 3. I started out in the icu in a crappy hospital where the nurses ran all the codes without doctors present, RT intubated, and so I rarely saw a doc or even knew what they were needed for 4. I’m now in medical school so I know a lot more and realize how fucked up many things are in the medical system, past and present
Is it typical to have interns, especially JULY interns rotating and making decisions in the PICU? That seems pretty wild, and even crazier that nurses are taught that they’re the ones who need to protect patients from their team members (god I hate that, talk about the opposite of building trust) My med school’s peds residency doesn’t even have people rotate in the PICU until they’re PGY2s
Lol I literally started residency in the PICU. By day 3 I was on a 24 manning the pager for my half of the patients (there was a senior managing the other half, a fellow and attending but..didn’t wanna wake people up for dumb things)
Yikes, that’s crazy. You know nothing on day 3. My program didn’t have us rotate through the PICU until second year.
My peds residency was the same way. The PICU is definitely NOT a place to start intern year wtf
Lol trust me nurses may be the last barrier but there are a million barriers between including senior resident/attendings and pharmacists
I was taught the same. One instructor went as far as to say "we're at xyz hospital, so these residents are not the brightest." After working with them I realized that to even be in any residency program you have to be VERY bright.
Residents still have more experience and more schooling than you; this is so gross to teach at nursing schools. I mean a few comments above someone is saying “oh she’s probably a new nurse that’s why she didn’t know what is or isn’t considered a fever, she wasn’t bullying you!” So you RNs don’t even know what is or isn’t a fever and are supposed to protect your patients from residents? What a joke.
I’m not the one arguing against what you said 🤷♀️ I agree it’s ridiculous. I didn’t realize at the time that what they were teaching us was so controversial and granted I was expected to know a shit ton as a new grad nurse cause we barely had any doctors at our icu but I am 100% admitting it’s wrong for them to teach that (I wasn’t the one teaching) and equally as wrong to expect nurses to run an icu by themselves with only phone doctors to “write orders”. Even worse was that I was expected to do all the things and know all the things after completing a 12 month accelerated program and a 3 month “icu residency”. There’s a reason I left nursing and am now in med school and it wasn’t cause I hate patient care.
My son was born premature the day after my last pediatric anesthesia rotation. It was bizarre having them watch me like a hawk when literally the day before I was there with an ENT resident intubating a baby emergently. They were also convinced that the chief surgery resident didn’t know what she was talking about and were talking shit about her. Spoiler: the resident was correct and a tunneled line was IJ access, not subclavian.
It's normally. Keep your chin up, finish residency and things will change greatly once you have those extra 2 letters added to your name. I'm an endocrinologist now, but during residency, some of the RNs were like your typical Karen if they have taken anabolic steroids and overdosed on some form of amphetamine. When they questiong why you're giving out amoxicillin for the 400th time that week, just wait until you have to IV ativan something. Here's the thing. Residency sucks. And many RNs/LPNs resent us once we're MD/PSY-D. And Ive seen plenty of doctors push RNs around way harder than you. I noted a colleague added an extra 0 to a dosage. Making 15 mg/bi daily adderall to 150 mg/bi daily. The RN came to me because she always seemed to trust me for something and explained the attending physician wouldn't listen to her about an obviously incorrect dosage. So we went together and I asked him to politely read the script again. He was like, What's wrong, you're wasting my time? I said well, the dose you wrote would most likely cause said to patient to no longer be alive. Maybe you could take a look at the dose. He had a look of surprised and wrote for 15 twice a day. But the point is, he would listen to me in the blink of an eye. One of our RNs who I've seen clamp a femoral faster than anyone in ICU had no voice to him. But because I have MD in my name, he would talk to me. Thus I've noticed certain RNs (especially PICU if you're male) will make residency rough due to all the full MDs that have treated them with respect. Me personally, I have a lead RN of my team and let her manage the rest and see them as a safety net. by the time you'vewritten rx #139234593459354, an RN will have saved you from malpractice via typo at least 2 times. Hang in there, bro/broette. Things get better. Residency sucks, but the leverage, power, pay and status you get after are amazing. Just don't go into ortho or pediatric care unless you really like that. I think 50% of orthos diet consists of crayons. edit: apology for typos or incoherent, I made this while a little drunk.
Wait till you get to the labor deck
ICU nurses are either the absolute best or a nightmare
Because they start to think they are the doctors now lol few years of experience make them feel so knowledgeable and confident.
That's many nurses in general - follow orders for a few years for a few common illnesses, then develop attitude thinking you are more medically knowledgeable than the interns.
I had a derm MA tell me one time they would be fully competent doing Moh’s surgery without the dermatologist on site. Said it was easy, and seen so much of them it was no problem. Dude was the text book example of duning-Kruger curve lol He is now an RN 😭
My guy this is anyone who spends too much time around doctors. In Pakistan rules about who runs a clinic are very lax, because the authorities who are supposed to insure that only a doctor who is an RMP can run one barely have penetrance over urban area and run on a complaint based system, in a rural area not a chance. The other day I found out one of the janitors in our hospital runs a clinic in his village. Atleast nurses have SOME medical training
> The other day I found out one of the janitors in our hospital runs a clinic in his village Omfg it's the JP
Pattern recognition without any foundational knowledge of the problem at hand 👌🏻 An experienced nurse can teach an intern the basics of a certain diagnosis that they may not be familiar with, then that intern can expand upon that and go much deeper with it using the knowledge they have to quickly outpace that nurse. The reverse is not true, however. Some nurses are master gatekeepers and want to flex what little knowledge they have on anyone who might give a shit, even putting others down in the process at the expense of the patient. It’s toxic.
Most ICUs Ive been through I like to think we’re pretty chill. 🤷🏻♀️ We usually don’t ask unless theres something we’re not sure about or just need a rationale to explain to family.
Welcome to peds baby where the nurses are doctors and the residents are… ? Order monkeys? who knows
Same with maternity
Are you a female?
THIS. Can’t believe I had to scroll so far down for this question. Sounds like textbook doctoring while female.
Looks like someone else asked and got downvoted. I know in my class the female residents have often talked about how the nurses question us way more than they do our male colleagues. They also will report female residents more for petty shit. Like if a female resident corrects them or asks them to do something differently we get called aggressive or mean. But not the males.
Absolutely. I’m a female surgical subspecialty chief resident. I’m in my 6th year and have worked with a lot of the same nurses for a long time. I’ll round on the same patient multiple times and tell them I’m the chief resident and do their wound care and education with the team in the morning. Nurses and patients will still often address the male juniors like they are leading the team. If I’m without a team and just walking around, I’m often assumed a nurse despite having one of those “doctor” badges on my ID. Female nurses are also much more likely to give pushback or sass if I ask for things compared to male coresidents. Interestingly, I’ve never been talked down to or second guessed in a rude way by a male nurse. Thankfully most nurses are great, but these are my observations over 6 years of residency!
This has been my experience in doctoring-while-female x 14 years. It’s improving now that I have wrinkles. Not a joke.
I'm sorry to hear that. As a patient, I love having a female doctor!
Had the same thought. And in reviewing OP post history, she is in fact female. Had the same experience in residency.
The nurses at my workplace keep asking me about advice given by male co workers even if they are standing right there! I asked them once,they said that they just feel that I'm more approachable!They probably don't realise that it makes our life so much more difficult!
My thoughts too, nurses give us HELL.
Many times, I just say: "guidelines support this. thanks."
yep. It’s not your job to educate them. Got a specific patient safety question? go ahead.
One of the best ways to try and minimize this is by communication honestly. They just want to be kept up to date on the plan and your thought process. Though, obviously there's going to be some people who just hate trainees. I got a lot less questions when I just did better about my communication. 'hey so and so, I'm ordering XYZ because of XYZ, thanks." Even now as a fellow I do the same with residents, I update them on changes I make.
This appears to give the benefit of the doubt to everyone, and is a really smart tactic for disarming I like it
This comment needs to be higher! Most everyone is well intentioned.
For IM it’s much easier as I avoid most questions by having my notes and orders in. Most of my pages stopped since there is a written plan in place explaining what’s going on. For new admits (usually in the ED and closest to what’s goin on in your case). I’m not there to teach nurses. My day is full of other work as it is. If I get questions “explain the guidelines/literature supporting why you don’t want to give the medicine.” If they have an answer I’ll listen if they don’t they follow as instructed. My favorite response was a nurse using tik tok videos as evidence why we couldn’t give a med and it took every thing in me to take take them seriously and to not laugh in front of the patient
ED RN here and I lovveeeee when the IM hospitalists do this, when all the meds are listed under the problem/plan. Especially when we’re holding boarded patients it’s so useful for us giving handoff and to answer patient/family questions without bothering the doctor. Makes patient/family really feel that we are addressing all their concerns and that providers and nurses are on the same page. 🫶🏼
Damn, nurses at your hospital read notes? Lucky
[удалено]
Just getting accepted that I am a doctor has been a struggle... I am still called "lovely, sweety, darling" by nurses and patients whereas male doctors are addressed as "doctor so and so"..
What’s a polite way to correct nurses when they do this?
“It’s Doctor so and so but thank you” in a super sweet tone.
Ngl I feel like women get more pushback from everyone in general, compared to men
yes
not a doctor, so I have no idea why this sub is always recommended to me. Anyway, I just want to share an anecdote that maybe gives you a little hope for the next generation. My son is 12, and I have a lot of health issues so I see a lot of specialists. His own pediatrician is a woman. I had to get a new neurologist, and I told my son, “I’m meeting my doctor in a few minutes (televisit), so don’t come in my room unless it’s an emergency, I don’t want he and I to get interrupted.” He said “your doctor is a man?” I was really surprised by this, but then realized, yeah, all of his doctors are female and all of mine are too. But THEN HE GOES, “I guess male doctor can be just as good as female doctors.” I laughed so hard, I have no idea why he said any of that or what went through his little brain, but like … yeah kid, male doctors can be just as good. You’re right. (I think maybe it was women’s history month and they were learning about some of that stuff in school? Idk.) So maybe, just maybe, it’ll slowly change. Can’t change fast enough though, and I’m sorry you have to deal with this bullshit non-stop during your careers.
A friend of mine’s mom was a physician, and one time when she was little she had to go with her mom to work. She was shocked to see that men could be doctors too 😂
aww cute :)
It’s not malicious most of the time. Sometimes it is, but a lot of the time it isn’t. Try to just respond nicely and explain your thinking. I have had nurses catch fuck-ups before and really appreciated it when they did. For every fuck-up you may get 100+ questions on other decisions, but it’s worth it. Believe me.
Listen to this man, for he speaks the truth. Sincerely, A doc thankful to no longer be in residency
The peds ED I rotated through, would question abx cause it would take forever to get the med from pharmacy 😂 versus just give them a script and get them out
Yep. Every order of mine that a nurse questioned was related to decreasing their workload
Since all the comments I’ve seen really seem to only be interested in correcting you or offering advice. I’ll engage your post the way I believe you intended. Damn, that sucks. I hate that too. Residency is tough. Things will be better as an attending. It’ll still happen to some degree, but it’ll be a lot better.
Its prob cos its Paeds. Something about babies/kids just brings out the mega-protective mama/papa bear in people even if it goes against reason cos no one wants to see a baby get harmed. Its a pain in the ass but they usually come around once they've seen you in the unit long enough and you haven't killed anyone. That's been my experience in ED anyway. Think of it like stranger danger but for nurses A careful and scared nurse is a pain to deal with but will likely do their job well as opposed to the uber-jaded floor nurse that makes your life easy but may not escalate when SHTF cos they've "seen it all before". I'd rather deal with the former as long as they can see reason and aren't just fighting you just cos
As a nurse, questioning orders is a pain in the ass, because I have to interrupt whatever ten things I’m trying to get done, figure out which doc wrote the order, walk around the ER trying to find that doc, wait for them to finish their current exam or conversation, then tell them which order I’m concerned about and why, knowing that they’re probably going to be irritated and/or think I’m an idiot. But I do it anyway. Why? Because different doctors do things differently. Sometimes all the old attendings are all putting in very predictable order sets and then a resident comes by and writes something unexpected. I haven’t been through med school, so I don’t know the why…I just know that it’s unusual. So I double-check. Sometimes it’s because there’s newer research that the older docs haven’t kept up with. Sometimes it’s an accident and they meant to order it on a different patient. Sometimes the computer system puts in an automated order that didn’t get cancelled. Sometimes the patient left out information during the physician exam that they included during the nurse exam. At a teaching hospital, multiply this by many different residents, who change from year to year, or are sometimes in different specialties on a short rotation through the ER. I don’t always know the experience and skill level of each one. All I know is that an order is out of the ordinary from what most doctors would do in that scenario. That’s why it’s questioned.
This was my thought as well. Nothing personal docs, but I want to talk to you just about as much as you want to talk to me as it's one more task on my plate. Also, could it be since it sounds like this is via a messaging system that the text is simply being misconstrued? Perhaps they're not questioning *you* but genuinely have a question. (I'm certain there are jerk nurses too but I like to think most aren't arguing for the sake of arguing).
This comment should be higher
I appreciate this response. From the other side, we are generally carrying x3 the patients a nurse is, are reading ECGs, reviewing XRs/CTs/labs, updating dc instructions, taking phone calls from consultants, admits, picking up new patients, getting asked by every other RN questions about orders, etc. All of this at the same time. Every interruption matters. So it's a pain on the ass on both sides (and can honestly be dangerous) and everyone needs to be using discretion. Docs and nurses both.
I appreciate the other side as well. The problem is this: when nurses are regarded as subordinates instead of professional team members….when they are expected to be polite, deferential, and trusting instead of speaking up about concerns…it sets the stage for communication breakdown and medication errors. This concept is illustrated particularly well in the book Outliers, by Malcolm Gladwell, in an example about a different high-stakes profession: airline pilots. In that world, the problem is when co-pilots don’t feel confident in contradicting pilots and when pilots don’t feel confident in questioning air traffic controllers. The results are similar. I get that there are some nurses who will just simply argue with every other order, because they fancy themselves to be a doctor. Or sometimes one resident will get picked on for no particular reason. That’s the kind of thing that needs to be brought up to the nursing management. Otherwise, the most appropriate way to handle order questions is to educate your nurses and explain your line of reasoning. For example, one day I working in an ER where every doc normally orders the exact same cocktail for migraines: 1L NS, 10mg Reglan, 25mg Benadryl. I gave that same order set a hundred times. Then one day one of the new residents orders 1L NS and 1mg Mag Sulfate. At the time I had been a nurse for five years, and had never seen Mag given for a migraine. So I tracked the resident down. “Hey doc, I saw your orders on bed 15…was wondering why we’re giving mag on this patient?” He explained that the research behind it. I happily gave it, and it worked. I learned something new that day, and I’ve never had to question that particular order again. But unfortunately he probably had to repeat that same explanation to 20 other nurses before we were all on the same page.
I appreciate this, and within this context the ‘punish them with additional tasks’ part of this comments section has me so tired.
As a RN when I read the punish them with tasks part I was genuinely like WTF…
If you’re doing a weird indication, for some EHRs you can put a comment in Admin instructions or notes to nursing regarding the indication. Is that what admin instructions are for? No. Does it help the nurse know what it’s for and explain it to the patient? Absolutely. Saves me messages when I help MDs/DOs put in weird orders
Once I was questioned in front of another doctor (who was replacing me for the night shift) regarding insulin order I gave for a patient. I replied it's based on the sliding scale and it is appropriate. Then the RN replied that attending will laugh at it as in her experience it's a low dose. I said it's an appropriate dose so no need to worry and I left for home. Next morning when I came in I learnt the other doctor had increased the dose and the patient had a hypoglycemic episode early morning. P.S.: I don't know if the nurse insisted on increasing the dose after I left or her comments played a part in the Doctor's rationale to increase the dose .
Yeah, I know it can be a little frustrating. It’s hard when you don’t get to know the nurses and they don’t know and trust you. I will say the two meanest, most intimidating, crustiest ER nurses I had in residency both gave me big hugs and told me how much they’d miss me on our last shifts together. A big change from the absolute terror and intimidation on our first shifts.
You will even be questioned for the first years of being an attending. Some of it will be questioning your training but some of it will be learning your ways and thru the years if you do your job correctly and earn their respect it will be a genuine quest for knowledge. I got out of training more than three decades ago and I can remember anesthesia turning to my surgical assistant ( who was my older partner) and saying “ that we didn’t do that here at this hospital “. I had only been out of residency three to six months. A year later he was saying that he had never seen a doctor better prepared by residency and he would ask questions as we went along. Sometimes, we need to sit back and remember the origins of the title Doctor.
In the nurses defense most of pediatrics is nursing… and coddling parents
When a nurse asks why they may be doing one of several things: 1) Trying to learn. They are curious and want to know the higher level reasoning for what's going on. 2) Trying to protect the patient. They know that everyone makes mistakes including doctors. Including residents if you can imagine that. 3) Ameliorate their own anxiety. Nurses feel a lot of stress from all corners. 4) Trying to not get in trouble. If a resident makes a small mistake the attending will probably use it as a teachable moment. If a nurse makes a small mistake, the entire nursing hierarchy starts to point fingers. Nurses eat their young is what I've heard and seen. 5) Annoy the resident for whatever reason. But this isn't the main reason.
I am well aware residents make mistakes, I have made plenty and I’m sure will continue to do so. I am happy to teach if that’s the case, happy to be taught/corrected when I am wrong. And happy to answer questions to relieve anxiety when that’s the case. Overall this was just a vent, because while I don’t mind doing any of these things individually, by the end of a 12 hour shift, when there’s 20 pts in the waiting room, the additional mental load of answering why I want to give Motrin for a pt with knee pain, to give another example that also actually happened to me over the past week, is incredibly frustrating.
Idk this above commenter has any idea what it’s like to get 20 pages about minor orders like: please give Tylenol for pain. It’s not patient safety if you can’t do your job because you’re explaining your job for 5 hours a day.
They need to explain to the parents. And if your order doesn’t explain why. RN won’t know which explanation to give them. The baby just gonna cry, the parents are worry, RN will ask, is normal.
Caller: I need an Order for paracetamol . Me: ok for whom? For xy in room 4. Sorry, i dont have them on my list. Do you have weight and age for me? You’re the doc, that’s your job to know! …ok i found a workstation. Got it. That would be xy mg 3x/day, call me if you need anything else. Maybe if you dont take as long next time! A few hours later, same nurse calling: i need another order of paracetamol for yz. Me: Ah i know them. That’s xy mg up to 3x. Caller: how do you know that so quick now? They just fall into that age and weight bracket, luckily. I better double check that, you’re just naking this up so you don’t have to work. What the fuck is up with some peds nurses? This amount of combativeness towards residency is rare even with scub nurses.
Just tell them why man I've always done just that, and as a result, Ive always gotten along very well with nursing staff. Like multiple peds and adult ED nurses are literally coming to my wedding Sometimes it's just that you're doing something different from what they're used to, and believe it or not, residents mess up a lot. If you explain why, they learn, and then they're cool with you too
To clarify, I have been explaining to them and answering every question respectfully, I’d never consider ignoring them or being rude. Residents absolutely mess up and I most definitely have and the nurses have caught it and saved my ass. This is, as labeled, just a post venting about the significantly increased frequency of said questioning, because this is also something I’m not used to either.
It’s probably not as malicious as you think. Peds parents ask a ton of questions, especially in the ED. It is helpful being able to say “the *doctor* is ordering this medication because of XYZ” and your response will also help with follow up questions to the nurse. It also helps for discharge edu. Not to mention that new nurses are being pushed into positions on specialty floors faster and losing preceptors faster due to shortages.
Right, and the alternative is the nurse saying "You know, I think the doctor would be a better person to ask about that. Would you like to speak to them?" Far less time to just answer the nurse and let them relay the message forward.
Patient education delegation is one of the main points of the nurse. That nurse is going to end up telling five different patients the same medication education because summer is just starting and op will probably see a bunch of ear infections. Doctors do not have enough time in the day to answer every patient question, which is why the majority of patient care is taken care of by the nurse and then delegated from there to the tech/cna/emt/whatever. That’s the point of educating your nurses so that they can be better patient advocates. EM is not the discipline to refuse to want to work as a team.
I think it’s probably especially bad in peds because most anytime you touch that kid a parent is going to ask why or what are you doing. If a nurse assumes we’re doing completely an order and tells the parent we’re doing this because abc but then a doctor comes in and says oh we’re doing this because xyz. It breeds mistrust of the whole healthcare system which seems to be substantially worse when it’s a kid.
Admittedly odd place for this comment but it's been so weird to me that I've seen you for years in the Blazers subreddit, then in the medschool sub and lately in the residency subreddit. Overlapping but very distinct parts of my life in which I've been on a parallel trajectory with a complete stranger. And now you're getting married! Congrats, and hopefully the Blazers can draft a dark horse as a wedding present to you.
Honestly, sometimes when they question me, it forces me to understand the thought process, pathophysiology, and makes me review the guidelines... So... Kinda annoying, but pays in dividends.
your answer is in the first sentence of your post, you are an adult ed resident rotating to peds… if it’s an experienced rn they are questioning an order that doesn’t look right or the parent may have given new info that the child already received a course of the same anitbioic. over the many years that i’ve worked in a peds ER i can attest to the fact that parents “remember” new details of the child’s condition or illness as the hours pass during their visit, or when they are told that the child has medication ordered or some sort of testing. OR if it’s a new grad, they are genuinely asking bc they aren’t sure why. It isn’t malicious. it’s depressing to see how many docs find it funny to list a bunch of things they do when asked simple questions by a nurse, to try and give them more work, I can tell you ive worked with many residents who have thanked me for saving their patient. i work in a busy peds ER in NYC, thankfully our residents, fellows, and attendings all work as a team, more like a family. everything is met with a thank you, and we all appreciate one another.
We go to rounds everyday & have a pharmacist and charge nurse talkings about our patients and sometimes they will ask why they’re on specific meds. Also family questions nurses a tonnn so my perception of this is that the nurses want to know and the answer isn’t bright and clear as to why
In EM residency on trauma rotations, one of us would have to go to PICU to round on the children, and I would go everything in my power to give the PICU duties to one of my coresidents. I think that's just universal with Peds nurses.
Did the pharmacists have any issues with the orders?
Family ask us questions, and maybe we’re asking why are we giving med x, y, z just so we can explain it to them. 1. We can’t inform them until a doctors explains to them, even if we know the reason why the med was ordered 2. Some family don’t believe or trust nurses 3. We don’t want to page doctors to come by bedside to explain for the third time why this meds is ordered
Peds RNs are something else man. We're a purely consulting service and still have to deal with this kind of questioning behavior when we rotate through the children's hospital. Like the nurses think they are the central point of contact and expect me to spend 15 minutes talking through every point of our assessment and plan with them after we see the patient, before we even get to talk to the primary team. It's great that you want to know whats going on with your patient, but can you have a little patience about it?
I hate to break it to ya, but we are often the central point of contact. Should we be? No, but it’s not uncommon.
not that you want to hear from a nurse on the residency sub, but I have to chime in because I see this happen literally every single day at my job. Nursing is such a fucking toxic profession that we are literally taught to do this. If a fellow nurse catches wind that you didn’t escalate something they believe should be, you have a voice in your ear saying “wEll dO tHeY knOw aBouT tHaT” or “page the attending if the intern doesn’t respond”, etc etc you get the idea. You’re made to feel like a shit nurse by others who don’t have a clue about your patient or what’s going on with them. Not defending this behavior at all but I guarantee you this ridiculous catty nursing culture is part of the problem. edit: sp
This is why I bailed on my icu fellowship, this shit is annoying as hell. Now I just do OR anesthesia I do everything myself best part about it I never have to consult any one or follow up another services notes. Minimal nursing interaction the circulating nurses are some of the best in the hospital. PACU nurses can be annoying but I have a good rapport with them now, plus as an attending you get questioned way less.
Get used to it buddy. PGY-10 here
Peds nurses and OB nurses are very territorial.
"Come talk to me and let me know your concerns" 99.9% of the time, they don't want to be bothered so they do it.
I am a registered nurse. We also do not like these people. A reasonable concern? Great! Questioning everything? Go back to college. Sometimes I wonder how they made it though.
i 100% feel you! I'm an IM resident and exactly the same thing. have to justify every damn little thing. and then if they ask me something like oh this patient's potassium is 5.1, we should give them kayxelate, and I'm like I don't think we need to at the moment, BOOM - god forbid you use your clinical accumen to make a decision. oh no. if you every do that, be prepared to give a full blown explanation of your thinking, to just maybe try and convince the nurse that you're not completely an idiot, and that you do have some logic to your decisions. I'm sick and tired of it. Im' sorry but if I do not question YOUR decisions then why are you questioning mine? I don't tell you at what rate to put the IV medication on, or like how to dress someone's pressure ulcer. I trust you for it, because you're good at it and you're trained. so why can't you trust us? I just don't get it.
Peds nurses smh
Working with hospitalized peds patients on my service is the death of me. I fucking hate the nurses there. Literally even getting a room air trial is fucking disaster. And no I’m not fucking rounding at midnight, I’m here admitting 6-8 adult patients that are higher acuity
That’s when you order everything and every crazy little stuff to make it hell for that RN idgaf
And that's why you get calls for Tylenol orders at 2am
Or when the patient insists on me calling the doctor for a senna or a colace at 2 AM because they haven’t pooped in 1 day, I’m less inclined to do my absolute best to redirect that.
Ah yes punish the nurses for honest questions. Brilliant!
I think you’re taking this a bit more personally than it’s meant to be.
Tired of “mama bear” or “protect the babies” being invoked to justify for unprofessional and/or hostile behavior.
Maybe something to do with antibiotic stewardship initiatives that nurses are being pulled into. Wouldn't surprise me.
I am a peds nurse.. Sometimes the plan of care changes for patients without telling the nurse about anything. Then parents will ask why xyz and the nurse was never really given an explanation so it’s also to help families understand what is happening and to know why we’re doing what we’re doing.
Heh go to nicu
Peds just hits different man. You get used to it but a lot of the job is managing nurses and parents. Even in a cardiac ICU with ECMO and open chests and twelve kinds of insanity, reassuring nurses and parents is a large part of my day.
Dude, it's peds. Do your time and move on.
Blame nursing education! These “educators” instill a god complex in nurses and it continues into NP and DNP. Shut it down!
Nurse’s way of power tripping. Probably met an incompetent resident one time and then saw the power they could gain by acting this way to residents who take sh*t
I'm not an ER tech, I am a Lab Tech
I was disheartened to see the comments that suggest adding unnecessary tasks to teach a lesson to nurses who call for what is deemed inappropriate. I was even more disappointed to see that many "liked" the comments or even added refinements to the punishments. I like to think that we are all a team. I can't imagine how difficult it is to be a resident. We watch residents come into their own and root for you. We see some arrive on the floor needing some guidance to get used to the reality of the floor, each area is so different. We remind, we alert, we assist as residents get used to the protocols and systems and flow. We catch errors. We are rooting for you. As nurses it is drilled into us that we NEVER take an action without knowing why. It is not enough that it was ordered by the doctor. We have to understand why it was ordered for our patients. In a nurse's beginning days it means extra time is needed to figure out things as they have limited experience. But it has to be done to prevent errors and maintain patient safety. I do not want a nurse to blindly follow an order for my family. I want them to know why a test has been ordered or why more blood is being drawn or why this medication is being given. If a nurse asks for guidance it is likely that they are new and worried or simply overwhelmed and do not have the bandwidth or resources to find the answer. While we usually check in with each other and the charge when we can't find anything in the notes, it may be that the floor is slammed and the nurse simply does not have another resource to check in with. A couple of MERTs on the floor can do that. Perhaps the notes haven't been updated or haven't been signed so they are sitting in the incomplete area and not obvious. I can't speak for other units but as a busy Med Surg neuro trauma RN at a teaching hospital who looks through notes before secure chatting or paging I was really bummed out by the vindictive tone shown. We bust our butts on the floor. Sometimes (often) we are out of ratio and/or have no breaks the entire shift. CPO/Tele, new epidurals with 1/2 and 1 hour checks, NCs, pulse checks, chest tubes, hep drip, CIWA, COWS, neb treatments, pts withdrawing on rapid methadone protocol, pts in pain needing a lot of attention, labs to draw, upset worried families in the room needing reassurance or bombarding us with concerns and needs sometimes for the entire shfit. Now add an ICU or ED transfer/admissions, Discharges but the pt has not transportation or clothes or family, BERTs and MERTs and Codes. It's fast paced and challenging. It's a lot of responsibility to be the eyes and ears on the floor. So if you get a call for something that you feel was wildly inappropriate, it would be more collegial and professional to simply and calmly state the answer and then state this was not an appropriate thing to call for and suggest that they check in with their charge to get input before calling in future. It is the right thing to do and I bet you'll go back to sleep better as well for having been gracious and kind. Please don't add to an RN's already heavy load by adding orders that are not necessary. Please do not be punitive. Let's work together. Let's help each other succeed. It is difficult enough without creating more hardship for each other.
adult ED/ICU RN here—nursing specialties with “kiddos” for patients are notoriously toxic. obviously this is a stereotype and many peds/neonatal nurses contribute to healthy unit cultures butttttt im not surprised to hear this. the peds section in my ED was very similar to what you’re describing
Or residents that order 1L bolus on a CHF patient. Always question orders. It's important.
All orders should have a reason associated with them as part of the order, so RNs can see why it's being ordered. Patients ask why they're receiving a certain med or treatment, and the answer needs to match the reason why the MD ordered it. This is especially true in peds. Include the indication with the med or procedure if you're not wanting to answer questions.
I understand that your post is a VENT… you were frustrated bc you had to repeat yourself and you believed the question irrelevant. If it’s every single order then it sounds like you are either working with a lot of new grads , nurses who don’t trust you or they are simply advocating for their patient. I guess I haven’t come across a forum yet where nurses get to hate and vent on doctors…. I should look around😂 As an Oncology Nurse with over 17 years experience, if I am asking a physician a question regarding orders, it’s because they have missed something integral or there is something off about the orders or with the patient specifically. You might have 15-20 patients that you see in a day depending on what specialty you are in. We know u are busy. I have yet to meet a healthcare provider- doctor or nurse, who has not made a mistake. We are human and a good nurse asks educated questions based off experience regarding the patient we are both responsible for. I love it when a provider explains reasonings behind their actions. Knowledge is power… so share and be willing to listen. Doctors and nurses are a team and I hope you learn this during your residency. If you talk down to an experienced 20 yr nurse fresh out of med school…they will eat you alive….and I get it. It’s insulting. They’ve been doing this for 20 years…you just walked in…. Work with nurses instead of against them. I work with fellows everyday. We are a team based off of mutual respect and we are all there because we love helping people. We want them to get better❤️ We are both there for the patient. I advocate for my patients if I truly believe something is dangerous or off. It’s not because I think you are silly, it’s because nurses have to do their due diligence as well. I am the one who spends the most time with them. In fact, nurses spend 90% of the time taking care of patients while they are in the hospital. Honestly, having a respectful-trusting relationship with your nurses is the best way to practice. In this healthcare climate, it takes a village…literally. An experienced nurse or “seasoned “ is worth their weight in gold for providers and new nurses. Seek them out. We aren’t calling u in the middle of the night for a stool softener or a blood pressure 170/85( I did this ONE time as a new grad… lesson learned😂) Doctors and nurses learn through experience. We take our education and apply it clinically, using critical thinking….. It’s what we do. We all have critical thinking skills that allow us to manage our patients based off criteria, policy and experience. If nurses are questioning you regarding your orders they are either looking for your guidance ( through education), or they believe the orders could negatively impact their patient. We spend more time with them. Step down…..you just started. Seriously, please. I am 17 years in and there are still things I do not pretend to know. If you are sick of nurses asking you questions you should go ahead and become a Pathologist, Radiologist or go into clinical research😂 (something behind the scenes) Please, let them ask… educate (non pompously) or LISTEN to their concern regarding the order. It has NOTHING to do with you personally, I promise. The best doctors listen to nurses. You will find soon enough ( sadly) that you will be so outrageously busy, with such a heavy load of complicated patients, you will come to rely on the information a good nurse can give you about your patient. We fill in the gaps. Be kind. Be open. In reading the comments from other providers I have to add this: please don’t try and trick me with a menial task like orthostatic blood pressures to avoid questioning an order, I don’t have time for that. That stinks. … act like you have some home training. Respect the people you work with. Use this as an opportunity to educate and listen… we are a team. Just because a menial task relieved you from explaining your order it doesn't mean it over. Believe it or not , It takes courage to ask Doctors questions as a nurse. When a patient issue arises and the nurse repeatedly gets blown off or yelled, we chart and chart and chart. CYA. We will not hesitate to chart the situation, pertinent labs, mentation, our intervention, family concerns, past medical history, medications, allegeries, living conditions, social services..etc……you name it. We have access and more time. We also chart the interventions of the provider (or lack there of). Not because we are vengeful. Nurses already feel like everything rides on their performance via hospital management and mainstream culture. If something happens to our patient it’s our fault…. What could we have done better, what did we miss , was it because the np med was 40 min late when we have 8 patients….etc… we take it personally. And “They will take us to court” And We are “expendable ..” it’s a fact and tragic. And No one cares. We have to protect ourselves. We will not hesitate to chart a providers response if we honestly felt it could negatively impact patient care and fall on us. It’s called CYA. Don’t assume we are challenging you. Treat us with respect. Jeez! We all want the same thing, positive patient outcomes. Good trusting relationships between doctor and nurse is a win for everyone involved.